Provider Demographics
NPI:1477915684
Name:MEDSTAR HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:MEDSTAR HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-322-8983
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-0123
Mailing Address - Country:US
Mailing Address - Phone:314-322-8983
Mailing Address - Fax:
Practice Address - Street 1:3904 HERMANS LAKE CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1561
Practice Address - Country:US
Practice Address - Phone:314-322-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-26
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health